Comparison of early and delayed umbilical cord clamping in newborns

Izhodišča: Prekinitev popkovnice pri novorojenčku je v porodništvu še vedno predmet raz- prav. Tako ločimo takojšnjo prekinitev popkovnice, ki se običajno izvede v prvih 10, 15, 30 ali celo 60 sekundah po rojstvu, in odloženo prekinitev popkovnice, ki običajno pomeni prekinitev popkovnice več kot 60 sekund ali 2–5 minut po rojstvu, ob prenehanju pulzacij popkovnice ali ob pojavu posteljice v porodnem kanalu. Takojšnja prekinitev popkovnice je ena od treh komponent aktivnega vodenja tretje porodne dobe, ki se je v modernem porodništvu uveljavilo v zadnjem stoletju, medtem ko je v nekaterih severnoevropskih državah ponekod v ZDA in Kanadi ter v razvijajočih se državah bolj aktualen fiziološki pristop. Zaključki: V zadnjih letih se takojšnja prekinitev popkovnice v številnih smernicah vse bolj zamenjuje z odloženo prekinitvijo, saj so raziskave potrdile številne prednosti slednje. Med najpomembnejšimi prednostmi odložene prekinitve popkovnice omenjajo višjo raven hemoglobina in feritina, večje zaloge železa, zmanjšano pojavnost anemije zaradi pomanjkanja železa, boljšo kardiopulmonalno prilagoditev in daljše trajanje zgodnjega dojenja pri donošenem novorojenčku ob nespremenjeni pojavnosti poporodne krvavitve pri materi. Prednosti odložene prekinitve popkovnice se kažejo tudi pri nedonošenčkih. Kljub vsemu je potrebna previdnost zaradi možnega pojava policitemije s hiperviskoznostjo, hiperbilirubinemije in dihalne stiske.Background: Umbilical cord clamping in the third stage of labour is still controversial. Early cord clamping is defined as clamping at 10, 15, 30 or 60 seconds after delivery, and delayed as clamping after 60 seconds or at 2–5 minutes after delivery, when the cord stops pulsating or when the placenta is visible within the birth canal. Early clamping is one of the three components of active management of the third stage of labour, which has been widely used in modern obstetrics during the last century. However, in some northern European countries, various parts of the USA and Canada and in developing countries physiological management is preferred. Conclusions: After publication of several trials describing the advantages of delayed clamping, this has recently been progressively replacing early clamping. Among the most important advantages of delayed cord clamping are higher haemoglobin and ferritin levels, higher iron stores, lower incidence of iron deficiency anaemia, better cardiopulmonary adaptation and longer duration of early breastfeeding in term neonates, while there is no increase in the incidence of postpartum haemorrhage. Delayed clamping seems to have some advantages for preterm neonates as well. However, caution is still advised because of the possible occurrence of polycythaemia with hyperviscosity, hyperbilirubinaemia and respiratory distress